Thalidomide is notoriously well-known for its severe birth defects and associated temporary market withdrawal in 1961. However, its medical benefits in treating multiple myeloma (a type of blood cancer) have brought it back to the market in 1998. How exactly thalidomide works is unknown. It may work on the part of your immune system involved in inflammation.
Thalidomide is highly effective for erythema nodosum leprosum (reactive condition to leprosy treatments). It has also been used as an off-label medication (meaning not officially approved by Therapeutic Goods Administration) for many other skin conditions including HIV-associated aphthous ulceration, neutrophilic dermatoses, prurigo nodularis, systemic lupus erythematosus, cutaneous sarcoidosis, bullous pemphigoid and many more.
Thalidomide should not be taken if you are:
– Allergic to thalidomide
– Pregnant or Planning a pregnancy
– A woman of child-bearing potential not on reliable contraceptives
– Men wishing to father kids or engaging in sexual intercourse with women of childbearing potential
– A patient with existing peripheral neuropathy
Thalidomide may not be suitable if you have:
– Significant liver or kidney failure
– Congestive heart failure or high blood pressure
– Constipation, or GI disorders
– Neurological disorders
Before starting the medication, your doctor may carry out some clinical examinations & tests to ensure you have no baseline nerve problems. Your doctor may also order some basic blood tests including a full blood count, liver & renal function and a pregnancy test, if you are female.
It is very important to follow your doctor’s instructions carefully when taking thalidomide. You must return for regular follow ups to monitor for side effects and to assess your response to treatment. You will also be required to have regular blood tests to monitor for side effects
Thalidomide used to treat skin conditions should be prescribed a dermatologist. The dose will depend your skin disease, the other drugs you are taking and your other medication conditions. The dose may be adjusted by your dermatologist depending on its side effects and the response of your skin condition to it.
The effect of thalidomide on erythema nodosum leprosum is very fast (24-48 hours). However, its effect on other skin diseases, if effective, may be slower (around 2-4 weeks usually).
Common side effects:
– Severe Birth defect
– Constipation, indigestion, nausea, vomiting, stomach pain or dry mouth
– Drowsiness, sedation, dizziness, shaking (tremor), headache or blurred vision
– Dry skin, red hands, or skin rashes.
– Swelling of the hands and feet,
– Low heart rate & or blood pressure;
– Reduced sexual drive or irregular periods
Peripheral nerve problems include numbness, tingling, weakness or unexplained pain of the hands, feet, arms or legs
Uncommon side effects:
– Liver damage
– Blood clots
– Endocrine changes: low thyroid hormones, low blood sugar levels
– Very low white and red cells
– Severe allergy to thalidomide, esp in HIV-positive patients
– Pregnant women MUST NOT take thalidomide
– Women of child bearing potential will require two reliable forms of contraception at least a month before, during and for one month after stopping thalidomide
– Men must wear a condom during sexual intercourse, not father a child or donate semen while on thalidomide and for one month after stopping the treatment.
– You should minimize alcohol intake as it may increase the sedating effects of thalidomide and increase the risk of liver damage.
– You should avoid smoking as it may increase the risk of blood clots.
– You should be extra careful when driving as thalidomide due to its sedative effects.
– You should not give blood during or for 4 weeks after stopping thalidomide treatment.
– Let your doctor know If you feel unwell/experience any adverse effects as above.
– Thalidomide has a number of drug interactions, some potentially dangerous. You must inform doctors or pharmacists that you are taking thalidomide.
This information is intended as a guide only. Please refer to the product information leaflet included in the medication pack for more details.
Further information Visit
Davis LS et al, Miscellaneous systemic drugs in Comprehensive Dermatologic Drug Therapy (3rd ed) by Wolverton SE, 2013. Elsevier.
This information has been written by Dr Cathy Zhao and Dr Tanumay Raychaudhury